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As I alluded to earlier, I was leaving the press room one afternoon at HIMSS14, and there I see former national health IT coordinator Dr. Farzad Mostashari hanging around Gregg Masters and Dr. Pat Salber of Health Innovation Media. It turns out, Masters and Salber had just pulled Mostashari aside to do an interview on video, but they didn’t have anyone to interview him on camera, so they asked me right there on the spot to be the interviewer. Here is the result.

Mostashari, now a visiting fellow at the Engelberg Center for Health Care Reform at the Brookings Institute in Washington, discussed how the years of searching for a business model to coordinate care and engage patients is finally starting to pay off. Always the champion of the little guy in healthcare, Mostashari also brought up the notion of physician-led ACOs, or, as he called it, the “Davids going up against the Goliaths.”

I had pretty much no preparation for this interview. It probably shows. I still think it worked out well.

I finally got the opportunity to catch the documentary film “Escape Fire,” a good 15 months after it went into limited theatrical release and became available in digital formats. I thought it would be an eye-opening exposé of all that ills the American healthcare industry, particularly for those who somehow believe we have the greatest care in the world. I excitingly ran this graphic when I first mentioned the movie on this blog back in October 2012:

The well-paced, 99-minute film interviews some notable figures in the fight to improve American healthcare — safety guru and former CMS head Dr. Don Berwick, journalist Shannon Brownlee, integrative medicine advocates Dr. Andrew Weill and Dr. Dean Ornish — as well as some lesser-known people trying to make a difference. It goes through a laundry list of all the culprits in the overpriced, underperforming mess of a healthcare system we have now, and examines approaches that seem to be producing better care for lower cost.

I expected the movie to have a liberal slant, but it really stayed away from the political battles that have poisoned healthcare “reform” the last couple of years. About the only presence of specific politicians were clips of both President Obama and Senate Republican leader Mitch McConnell both praising a highly incentivized employee wellness program at grocery chain Safeway that reportedly kept the company’s health expenses flat from 2005 through 2009, a remarkable achievement in an era of escalating costs.

However, filmmakers Matthew Heineman and Susan Froemke did discuss all the lobbyists’ money presumably buying off enough votes in Washington and at the state level that has helped entrench the status quo. They even scored an interview with Wendell Potter, the former top media spokesman for Cigna, who became a public voice against abuses by health insurers because his conscience got the better of him. As Brownlee noted in the film’s opening, the industry “doesn’t want to stop making money.”

Other reasons given for why healthcare is so expensive, ineffective and, yes, dangerous include:

direct-to-consumer drug advertising leading to overmedication;

public companies needing to keep profits up;

fee-for-service reimbursement;

the uninsured using emergency departments as their safety net;

lack of preventive care and education about lifestyle changes;

a shortage of primary care physicians;

cheap junk food that encourages people to eat poorly; and

severe suffering among the wounded military ranks.

The filmmakers also kind of imply that there isn’t much in the way of disease management or continuity of care. Brownlee described a “disease care” system that doesn’t want people to die, nor does it want them to get well. It just wants people getting ongoing treatment for the same chronic conditions.

One physician depicted in the movie, Dr. Erin Martin, left a safety-net clinic in The Dalles, Ore., because the work had become “demoralizing.” The same people kept coming back over and over, but few got better because Martin had to rush them out the door without consulting on lifestyle choices, since she was so overscheduled. “I’m not interested in getting my productivity up,” an exasperated Martin said. “I’m interested in helping patients.”

Another patient in rural Ohio had received at least seven stents and had cardiac catheterization more than two dozen times, but never saw any improvement in her symptoms for heart disease or diabetes until she went to the Cleveland Clinic, where physicians are all on salary and the incentives are more aligned than they were in her home town. As Berwick importantly noted, “We create a public expectation that more is better.” In this patient’s case, she was over-catheterized and over-stented to address an acute condition, but not treated for the underlying chronic problems.

The film also examined how the U.S. military turned to acupuncture as an alternative to narcotics because so many wounded soldiers have become hooked on pain pills. One soldier, a self-described “hillbilly” from Louisiana, got off the dozens of meds he had become addicted to and took up yoga, meditation and acupuncture to recover from an explosion in Afghanistan that left him partially paralyzed and with a bad case of post-traumatic stress disorder. The only laugh I had in the movie was when he told the acupuncturist at Walter Reed Army Medical Center in Washington, “Let’s open up some chi.”

I kept waiting and waiting for some evidence of information technology making healthcare better, but I never got it. After leaving the Oregon clinic, Martin took a job at a small practice in Washington state where she was seen toting a laptop between exam rooms, but, for the most part, I saw paper charts, paper medication lists and verbal communication between clinicians.

What really bothered me, however, is the fact that there was no discussion of EHRs, health information exchange or clinical decision support, no mention of the problem of misdiagnosis, no explicit discussion of patient handoffs, continuity of care, medication reconciliation and so many other points where the system breaks down. You can’t truly fix healthcare until you address those areas.

WASHINGTON—I’ve just finished 2 1/2 days of helping US News and World Report cover its inaugural Hospital of Tomorrow conference. My assignment was to sit in on four of the breakout sessions, take notes, then write up a summary as quickly as possible, ostensibly for the benefit of attendees who had to pick from four options during each time slot and might have missed something they were interested in. Of course, it’s posted on a public site, so you didn’t have to be there to read the stories.

The one on infection control was particularly interesting, in large part due to the panel, which included HCA Chief Medical Officer and former head of the Veterans Health Administration Jonathan Perlin, M.D., Johns Hopkins quality guru Peter Pronovost, M.D., and Denise Murphy, R.N., vice president for quality and patient safety at Main Line Health in suburban Philadelphia.

On first read, I gave it a big “Duh!” for the explanation that the Patient Protection and Affordable Care Act (that’s how the law is officially known, Mr. Friedman) creates a “new industry” of innovation by encouraging the federal government to release of terabytes of health data — information already legally in the public domain — and then allowing the private sector to figure out how to structure, interpret and use the data. As you probably are, I’m well aware of digital health, Health Datapalooza, federal CTO Todd Park and some of the companies Friedman mentions. (Health Datapalooza IV is less than a week away.)

But on second read, I realized Friedman needed to write that column because America needs a lot of education about the Affordable Care Act, education that the Obama administration and its supporters don’t seem all that willing to provide. The public still thinks of Obamacare largely in terms of health insurance coverage. It’s much more than that, including, as Friedman points out, an attempt “to flip this fee-for-services system (which some insurance companies are emulating) to one where the government pays doctors and hospitals to keep Medicare patients healthy and the services they do render are reimbursed more for their value than volume.”

Coupled with the 2009 American Recovery and Reinvestment Act, which created the $27 billion EHR incentive program for “meaningful use” of electronic health records, the ACA takes some steps toward actual reform of actual care, not just insurance coverage. Friedman does not discuss Accountable Care Organizations, an experiment in realigning incentives around care coordination, nor does he mention the Medicare policy, dictated by the ACA, of not reimbursing for preventable hospital readmissions within 30 days of initial discharge for certain specific conditions, currently heart attack, congestive heart failure and pneumonia. Likewise, he fails to bring up outcomes research, another component of Obamacare. But at least he gets something out there that’s not about insurance coverage.

Unfortunately, many of the online comments posted in response to Friedman’s commentary predictably focus on insurance coverage or government control, but some actually discuss EHRs, population health, healthy behaviors and payment incentives. That’s good. Still, those are just people who read Friedman and the Times. Hyperpartisan conservatives — probably even some hyperpartisan liberals, even though the ACA is more centrist than a lot of folks wish to admit — and the less-educated won’t read the column and won’t comment on the Times site. Those are the people who misunderstand this imperfect but occasionally reform-minded law the most.

I just got a robocall from my primary care physician’s office asking first if this was actually me — not that anyone would actually lie — and then if I had received a flu vaccine this season. Well, the practice itself administered the vaccine last month, so they should have known that the answer was yes. I did say yes to the interactive voice-response system and also provided the month, as asked.

I realize it is good to make sure that patients get the recommended preventive care and that it may be impossible for staff in a small practice to call every last patient, but robocalls are awfully impersonal. If the system had actually been connected to the practice’s EHR, I wouldn’t have needed to get the call in the first place. Or maybe someone forgot to enter the vaccination into the record? In either case, the process is imperfect.

Yes, it’s a small deal, but how many imperfect processes are there in medicine? Little things have a way of adding up.

Yes, after all these years of writing about EMRs, EHRs, PHRs, patient portals and the like, I have had my first real personal experience with a patient portal, courtesy of my internist.

He still has a small practice, with four other physicians, including one fresh out of residency. Those small practices are a dying breed, but this doctor is changing with the times, too. He recently offered a concierge option for a few hundred patients. I declined because I don’t need to reach him that urgently.

The portal has been in place for a couple of years, and I may have logged in once or twice before to set up an account, but didn’t really do anything other than look around. This time, prompted by an e-mail informing me of a new URL, I logged in and checked my medication list. I remembered that another doctor had changed the dosage of one of my medications a while back, so I fired off a secure message informing this practice of the change. (It was a new URL presumably because the EHR vendor formerly known as Sage Healthcare adopted the Vitera Healthcare Solutions name a year ago and was switching its customers to a common, white-labeled portal.)

I also looked at some of my test results from a year and a half ago just to confirm that everything was more or less OK then, though I did see one abnormality with my HDL cholesterol. I last went for a physical in March 2011, about a month after I ungracefully cut my face open on a bathtub in Orlando during HIMSS11, so I was probably due. This practice lets patients request appointments — not actually choose open slots — online, so I sent my request. Tonight, about 24 hours later, I got my confirmation, and I’ll be seeing the doc in a couple of weeks.

It’s not a perfect system, but it was convenient enough for a night owl like myself who might not remember to call during business hours to make an appointment or simply not want to wait on hold or press a bunch of buttons to navigate a telephone menu. I did not see the Blue Button option to download my record that the federal government is pushing private vendors to adopt, but I’m sure that will be there by the time the practice is ready for “meaningful use” Stage 2 in a year or two. I don’t have a PHR anyway, so I wouldn’t be able to do anything with the data other than print it.

I suppose I should set up an emergency PHR at some point, even though I doubt any hospital or specialist I might get referred to would take the time to download my data from a USB drive or log into someone else’s portal. Untethered PHRs simply don’t fit physician workflow. That might change in MU Stage 2 when providers will have to send electronic discharge statements and patient summaries during transitions of care, but I’m still not convinced a patient-controlled PHR will be the right vehicle for these data transfers.

In a rare turn of events, I’m the one being asked the questions on a podcast by Sivad Business Solutions, which hosts regular audio discussions on a variety of business topics. I give kind of a high-level view of health IT and offer my very strong opinions on patient safety and healthcare reform. There’s an interesting discussion about EHRs being designed to maximize reimbursements rather than assure safety.

Interestingly, we recorded this via Skype. I like the audio quality, if not the nasal quality of my own voice, more than usual that day.

Consumerism hasn’t completely caught on in healthcare, but it has gained a bit of a toehold. Consider these two slides shown Monday at the Healthcare Unbound conference in San Diego:

Reasons why healthcare is so troubled

Look at the uptake of wellness electronics.

Look at the bottom of each slide, starting with the second one. According to GreatCall, maker of the Jitterbug phone for seniors, 35 percent of consumers plan to buy “wellness electronics” in the next year. That’s great news and a great opportunity for people in health IT to make sure such devices connect to larger networks to data collected will be usable.

In the upper slide, Kaiser Permanente cites numbers showing one reason why healthcare is in such a crisis. Again, look at the bottom. Just 2 percent of current residents in internal medicine will end up in primary care. That’s not exactly reassuring in the face of a projected shortage of 40,000 family practice physicians by 2020. Thus, connected devices will gain in importance as an adjunct to primary care for the purpose of disease management.

Free Healthcare IT Newsletter Want to receive the latest news on EMR, Meaningful Use,
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